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Acute cardiac life support > Powerpoint > Flashcards

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1
Q

Sinus node rate

A

60-100

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2
Q

Ectopic atrial pacemaker rate

A

60-80

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3
Q

Junctional ectopic pacemaker rate

A

40-60

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4
Q

Ventricular ectopic pacemaker rate

A

20-40

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5
Q

In a normal sinus rhythm, what is the P wave like in lead II

A

Upright

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6
Q

In normal sinus rhythm, what is the P wave like in aVR

A

Inverted

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7
Q

Rhythm in a premature ventricular contraction (PVC)

A

Irregular

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8
Q

P waves in PVC

A

Usually not seen

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9
Q

ST segment and T wave in comparison to the QRS complex in PVC

A

Opposite in polarity (discordant)

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10
Q

QRS complex in PVC

A

Premature (obviously) and wide

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11
Q

Is there a full compensatory pause in PVC?

A

Usually

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12
Q

Shockable rhythms

A

Vtach and vfib

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13
Q

Nonshockable rhythms

A

Asystole, Pulseless electric activity

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14
Q

Difference b/w defibrillation and synchronous cardioversion

A

In defib the shock is delivered w/out regards to the cardiac cycle, whereas with cardioversion the shock is delivered when the QRS complex is sensed

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15
Q

Indications for defibrillation

A

Vfib, pulseless monomorphic vtach, sustained polymorphic vtach

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16
Q

Indications for cardioversion

A 
Unstable afib
unstable aflutter
unstable momorphic vtach
unstable narrow-QRS tachycardia
unstable
unstable
unstable
unstable...
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17
Q

Rapid irregular rhythm with chaotic activity and no recognizable P, QRS, ST or T waves

A

Vfib

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18
Q

Treatment for Vfib

A

Defibrillation: biphasic, monophasic, AED

CPR for 2 minutes: 30:2 ratio

Epi 1 mg IV every 3-5 minutes or vasopressin 40U (in lieu of 1st or 2nd epi dose

Amiodarone 300 mg IVP (may repeat IV bolus once in 5 minutes @ 150 mg) or lidocaine (if amiodarone not available) 1.5 mg/kg (max 3 mg/kg)

Defib after each step + CPR then recheck rhythm

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19
Q

Signs of unstable cardiac events

A

Signs of hemodynamic compromise; lightheadedness, SOB, diaphoresis, hypotension, chest discomfort

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20
Q

Treatment for stable monomorphic VT

A

Amiodarone 150 mg IV over 10 minutes or
Procainamide 20-50 mg/min IV (initially), or
Sotalol 100 mg over 5 minutes

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21
Q

Tx for unstable monomorphic VT

A

synchronized cardioversion at 100 J

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22
Q

Tx for pulseless monomorphic VT

A

Same as vfib

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23
Q

Tx for sustained polymorphic VT

A

Defibrillator

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24
Q

If the is QT prolongation and a nonsustained polymorphic VT, what is the Tx

A

Mg Sulfate 1-2 g IV

This is torsades de pointes

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25
No rate or rhythm discernible, no QRS complexs, P waves MAY be present (not usually)
Ventricular asystole
26
Tx for ventricular asystole
Check leads, confirm asystole Begin CPR Establish IV access Epi 1 mg IV every 3-5 min OR vasopressin 40U IV(1 dose to replace 1st or 2nd epi dose)
27
When do you stop resuscitation
Persistent asystole or agonal EKG pattern despite appropriate ACLS protocol and no reversible cause identified
28
Tx for PEA
Search for and treat reversible causes and... Begin CPR Establish IV access Epi 1 mg IV repeat 3-5 minutes OR Vasopressin 40 U (1 dose to replace 1st or 2nd epi dose)
29
Potentially treatable cause of PEA and asystole (H's)
Hypovolemia, hypoxia, hydrogen ion (acidosis), hyper/hypokalemia, hypothermia
30
Potentially treatable cause of PEA and asystole (T's)
``` Tablets (drugs) Tamponade Tension pneumothorax Thrombosis, coronary Thrombosis, pulmonary (embolism) ```
31
Sinus tachycardia characteristics
Rate: 101-180 Rhythm: Regular P waves: Uniform upright in II and always precedes a QRS complex
32
2 types of pathways in AVNRT
Fast and slow pathways
33
Describe the fast pathway in AVNRT
Conducts impulse rapidly but has a long refractory period
34
Describe the slow pathway in AVNRT
Conducts impulses slowly but has a short refractory period
35
AVNRT characteristics
150-250 BPM, usually 180-200 Ventricular rhythm is regular P waves often hidden in QRS complex QRS <.12 seconds
36
Supraventricular tachycardia (SVT) that starts and ends suddenly
Paroxysmal SVT (PSVT)
37
Rhythms that originate above the ventricles but the impulse travels via a pathway other than the AV node and bundle of His
AVRT; aka pre-excitation syndrome
38
3 major forms of pre-excitation syndrome
Wolff-Parkinson White syndrome Lown-Ganong-Levine (LGL) syndrome Syndrome that involves the Mahaim fibers
39
Short PR interval, Wide QRS complex, delta wave
Wolff-Parkinson-White syndrome
40
Rate in WPW
60-100 usually
41
PR interval in WPW
.12 seconds or less
42
QRS complex in WPW
Usually >.12 seconds
43
Atrial rate in afib; ventricular rate
Atrial rate is 400-600 (no discernible P waves) and ventricular rate is variable
44
Tx for unstable afib
Cardiovert
45
Tx for stable afib
Anticoagulate and control rate (BB, nondihydropyridine CCBs, digoxin)
46
Atrial rate of 250-350 with saw-tooth pattern
Aflutter
47
Tx for aflutter
Same as afib
48
Most common wide-QRS tachycardia
VT
49
Tx for unstable wide-QRS tachycardia
Cardiovert if monomorphic | Defib is polymorphic
50
Tx for stable wide-QRS tachycardia
If monomorphic AND regular, consider adenosine Otherwise... Amiodarone 150 mg IV over 10 minutes or Procainamide 20-50 mg/min IV (initially), or Sotalol 100 mg over 5 minutes
51
If you are giving adenosine for tachycardia, how much do you give for the 1st dose? 2nd dose?
1st: 6 mg rapid IV push follow with NS flush 2nd: 12 mg
52
Coughing, squatting, breath holding, carotid sinus massage, application of a cold stimulus to the face, Valsalva, and Gagging are all examples of what?
Vagal maneuvers
53
Rate considered bradycardic?
<60
54
Tx for symptomatic sinus bradycardia
Atropine .5 mg IV
55
P wave before each QRS, regular rhythm, prolonged (>.20 s) PR interval
1st-degree AV block
56
PR interval lengthens each cycle until a P wave appears w/out a QRS
2nd-degree AV block, Type 1 aka Wenchkebach
57
Every other P wave is followed by a QRS complex
2nd-degree AV block
58
P wave and QRS complex are completely separate from each other
3rd-degree (Complete) AV block
59
What do you do if atropine tx for unstable bradycardia is inneffective
Transcutaneous pacing OR Dopamine infusion OR Epinephrine infusion
60
Doses of atropine, dopamine, and epi to give in bradycardia
Atropine: 1st dose .5 mg bolus, repeat every 3-5 min, max 3 mg Dopamine IV: 2-10 mcg/kg/min Epi IV: 20 mcg per min

Acute cardiac life support (5 decks)

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